Sangho Moon

Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis.

BackgroundMedicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries.MethodsThe household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996–2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits.ResultsDual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals.ConclusionDual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program rather than the result of overutilization in response to the expanded benefits of the dual eligibility program. The dual eligibility program is particularly beneficial to Asian and Afro-American duals in association with the provision of home healthcare and dental benefits.

Direct‐to‐consumer prescription drug advertising: concerns and evidence on consumers' benefit

Purpose – The purpose of this study is to provide an overview of the economic and clinical impacts of direct‐to‐consumer (DTC) advertising on consumers and physicians.Design/methodology/approach – Controversy around the benefits and concerns associated with DTC advertising are summarized. The sources are sorted based on their position toward DTC promotions: defending or opposing. Two recent works by Woloshin et al. and by Weisseman et al. are discussed in depth to provide the empirical evidence for the impacts of DTC promotions.Findings – Notwithstanding many concerns against DTC advertising, evidence‐based papers report that both consumers and physicians are potentially benefited from it. Consumers rate the health‐related information contained in DTC advertising as important. Physicians do not feel that they are pressured to prescribe inappropriate medications driven by DTC advertising. Physicians perceive improved communication and education among DTCA‐influenced patients. However, consumers tend to ove...

HMO plans, self-selection and utilization of health care services

This study examines the effect of health maintenance organizations (HMOs) on the use of health care services among the privately insured, nonelderly population. To consider jointly the possible self-selection bias and high frequency of zero observations in the applied utilization measures, we accommodate the endogeneity of health plan choice decisions in the censored regression model. Using data from the 2000 Medical Expenditure Panel Survey, we find strong evidence for favourable self-selection into HMO plans. Health maintenance organization enrollment is found to encourage greater use of office-based and hospital outpatient services. Overall satisfaction with the quality of care among HMO members is relatively low compared to that among nonHMO members. These findings suggest that more effort is needed to develop management strategies in HMOs in order to contain the moral hazard in utilization and assure the quality of service provided within the network of HMO providers.

COOPERATIVE PUBLIC HEALTH INSURANCE SYSTEM: EFFECTS OF MEDICARE BUY-IN PROGRAMS ON HEALTH CARE UTILIZATION

The paper examines the effect of the U.S. Medicare Buy-In program, a cooperative public health insurance system, on the health care use among Medicare beneficiaries. Zero-inflated negative binomial (ZINB) regression analysis is performed over the sample of 8,262 Medicare beneficiaries extracted from the U.S. Medical Expenditure Panel Survey 1996–2000. Dual eligibles are correlated with more utilization of agency-sponsored home healthcare services. The high utilization of home healthcare services among dual eligibles is the result of delayed realization of unmet need under the conventional Medicare program, but not the result of possible over-utilization triggered by the Medicare-Medicaid dual coverage. The Buy-In program is found to be a supportive hand over the Medicare low-income group with unmet medical care needs. The program is particularly beneficial to racial minority duals (rather than white duals) in receiving home health care or dental services.